Tag Archives: cymbalta

Let’s Get Real About Antidepressant Side Effects

By Sean Hagey
The Mighty

Your doctor just wrote you a prescription for your depression. You were probably given some info on what the drug is, what they hope it will do for you and (if your situation is like mine) they may have mentioned “some mild side effects” may occur.

Maybe they don’t really know, or maybe they don’t want to frighten you, but I’ve found an alarming amount of doctors don’t inform you on just how common side effects are. In my experience, they certainly don’t tell you about the really intense stuff.

I remember coming back to the doctor after that very first prescription and had this interaction:

Me: I’ve been having a lot of headaches and stomach issues since I started taking that medicine.

Doctor: Yes, that’s unfortunately very common.

I didn’t say it out loud, but I definitely remember thinking, “That would have been good to know before I started taking this!”

Drowsiness and fatigue can also be common, which is wonderful because we depressives already struggle with fatigue and lack of motivation.

Weight gain is reported from many antidepressants. Great, now I have a body image issue to add to the mix. What kind of sick joke is this!

My journey through this valley of cupcakes and rainbows has basically been a cruel game of “Would You Rather?”

Nausea and other gastrointestinal issues are common. Fantastic. Now I can’t even enjoy my damn ice cream without feeling like it’s going to violently come back up.

It’s taboo to talk about, but sexual dysfunction is very common. It’s as high as 50% — or more! — in some studies. For guys, that can mean erectile dysfunction. For men and women, this likely means difficulty or inability to achieve orgasm. As if being depressed wasn’t already bad enough.

And last, but not least, there’s other weird stuff. Dry mouth, lightheadedness, dizziness, agitation and my all-time favorite, “brain zaps.” Yes, I’m talking about this really freaky sensation that I’ve only had when taking a type of antidepressant known as an SNRI (serotonin and norepinephrine reuptake inhibitors, such as Cymbalta, Effexor and Pristiq). My brain says, “You know what would really lighten up the mood around here? An electrical shock!” At that moment, a bolt of lightning starts in my brain and zaps out into my face, hands and feet. It’s like a party — in hell.

My journey through this valley of cupcakes and rainbows has basically been a cruel game of “Would You Rather?”

I’ve pretty much run the whole gamut. I don’t know if there’s some sort of prize for my achievements, but I figure I should at least be considered for the hall of fame of side effects. Perhaps I should start calling myself the Babe Ruth of depressives. Please, no requests for autographs though. I’m tired, nauseous and agitated, with a dry mouth and headache from dealing with these damn brain zaps.

Sometimes you have to laugh about it or else you’ll cry. And I’ve already met my lifetime quota on that. Plus, I’ve already written about how serious, scary and horrible it is to have a major depressive episode here.

Sean Hagey is a physical therapist assistant and technology consultant who writes about his battle with depression. He runs the blog, Mental Health Matters, which focuses on mental health advocacy and education.

This article was originally published on The Mighty. Reprinted with permission of the author.

The Right Way to Get Off Antidepressants

Crissi Estep had been on Cymbalta (duloxetine) a few years when the medication seemed to stop working. At first, it effectively controlled both her fibromyalgia-related nerve pain and her depression, but “any successes I had had with it earlier were gone,” Estep says.

“I was very depressed, even agitated, and felt like I had plateaued,” she added. When Estep shared her concerns with her physician, he added Abilify (aripripazole) to her medication regimen.

Estep soon developed intolerable side effects. Frustrated, she decided to quit taking her antidepressants.

Because she’s a registered nurse, Estep knew that antidepressant medications are usually tapered before they’re discontinued. So, she developed her own tapering schedule: 1 day between doses, then 2, until the medicine was gone.

Severe withdrawal symptoms hit about five days after the medication cleared her system. “I genuinely thought I was having a heart attack,” Estep says. “I had chest pains and was shaky and nauseous. When I turned my head, it would swish, like water in a bowl.”

The South Carolina resident was in Maine at the time, camping with her family, “literally googling ERs,” she says, when her husband wondered aloud if her symptoms might be related to the cessation of her medication. Together, they looked up withdrawal symptoms for her antidepressants. Estep was experiencing almost all of them.

Between 2011 and 2014, approximately 1 in 9 Americans reported taking at least one antidepressant medication in the past month. Sixty-eight percent of those people had been on their antidepressant for two years or longer; 25% had been taking anti-depressant medication for 10 years or more. At some point — typically, when they’re feeling better, but sometimes when they are frustrated by side effects — nearly every person who uses an antidepressant considers stopping the medication. But, as Estep learned, stopping antidepressant treatment without medical guidance is risky and can cause uncomfortable side effects, as well as a relapse of depression.

You should also know that the more depressive episodes you have had, the more time you should take to come off of the medication. Harvard Women’s Health Watch says that for those who have had 3 or more such episodes should wait for at least 2 years once symptoms ease to considering weaning off an antidepressant.

Regarding weaning off, it’s important not to taper off to quickly. Time is your friend and you should take things slowly. Coming off too quickly can increase the risk of nasty withdrawal symptoms, and increase the risk of a relapse. It’s not uncommon for some long-time antidepressant users to need a year or more to come off of medication.

The good news is there’s a right way to get off antidepressants.

Set Yourself Up for Success

The best time to go off an antidepressant is when your depression is in remission and life is stable. “Big life transitions, such as a job change, graduating from college, getting married or having a baby, are not a good time,” says Carl Olden, MD, a family physician in Yakima, WA, and a member of the board of directors of the American Academy of Family Physicians.

It’s also a good idea to bolster your support system and boost self-care strategies. “You’ll have the best chances of success if you have a team around you,” says Jane Payne, MD, a psychiatrist in private practice in Portland, OR. Ideally, your team will include the medical professional who prescribes your medication and at least one or two close friends or family members who know about your history of depression.

“Be as forthright as you can with them about what depression was like for you, about how your behavior changed, and let them know you’re going off your medication, so they can be on the lookout for red flags,” Dr. Payne says. Also share with them some successful coping strategies you’ve used in the past (such as journaling, exercise or time in nature), and ask them to encourage and support your self-care efforts as you transition off medication.

With your health care provider, develop a plan. Your provider will want to know how you fare on days or weekends when you forget to take your antidepressant. That information will help your provider plan an appropriate quitting schedule. And if your antidepressant serves multiple purposes – say, managing nerve pain and depression – your provider may need to prescribe another medication to keep your health under control.

Don’t let your antidepressant prescription lapse. Make sure you have some left, “in case you need to start back up,” Dr. Olden says.

Go Slow

“Any medication that you’ve been on for more than a couple of weeks that works on the central nervous system has initiated changes within the brain to adapt to the presence of that medication,” Dr. Payne says. “If you suddenly take the medication away, the changes are still present without anything to balance them.”

Gradually tapering – decreasing the dose – of the medication over a period of time allows your body to readjust. That’s why clinicians recommend weaning antidepressant medication over a period of weeks — and often for far longer than that.

The length of the weaning period will vary depending on the antidepressant, dosage, duration of treatment and individual response. It may take as little as 5 days, or a month or more to wean completely off an antidepressant.

Follow the weaning schedule recommended by your healthcare provider, and don’t hesitate to report adverse effects.

“If you’re having withdrawal symptoms, find yourself unable to sleep or your mood is really up and down, it might be that you’re coming off too fast,” Dr. Payne says. A more gradual approach could eliminate your symptoms.

Know What to Expect

Some people experience a transient increase in depression-related symptoms, such as difficulty sleeping, anxiety and agitation, while coming off their medication. Other adverse symptoms may include constipation, diarrhea, dizziness and nausea.

In most cases, these symptoms will subside within a few weeks. “This is why it really helps to be in contact with a doctor who has a sense of your baseline, who can tell the difference between a rough patch and things going south,” Dr. Payne says. When in doubt, call your physician, who can help you determine if you need medical treatment.

If your depressive symptoms re-emerge after you’ve stopped the antidepressant, you may need to restart the medication – and that’s OK. “There are some folks who are better served by staying on antidepressants,” Dr. Olden says.

Estep restarted her antidepressant while still on vacation. After she returned home, she spoke to her doctor and “did a very slow wean” that was “pretty uneventful,” she says. One month later, she was off her antidepressant.

Overprescribing: Do You Really Need to Take That Med?

Do you take 4 pills a day? If so, you’re like most Americans. Yet what are we taking all these pills for, and are they improving our lives?

The overuse of prescription drugs has become a serious problem in the US. We hear about this most in the context of opioids — narcotic painkillers whose widespread use and abuse has become a national crisis.

The overuse of antibiotics has also become the focus of an intensive campaign to steer doctors and patients to more judicious use.

The soaring use of prescription drugs has been driven by several factors: A plethora of new drugs coming to the market; a culture that has come to expect a “pill for every ill”; aggressive marketing to both doctors and consumers by the pharmaceutical industry; and treating some “pre-”diseases with pills rather than with lifestyle changes.

Between 1997 and 2016, the number of prescriptions filled in the US increased 85% — from 2.4 billion to 4.5 billion — even though the population increased by just 21%. Nearly half (49%) of adults take at least 1 prescription drug, 23% take 3 or more and about 12% take 5 or more, according to the latest data from the CDC (Centers for Disease Control and Prevention). One in 10 adults takes 10 or more drugs, and the average adult takes 4 prescription medications, according to a Consumer Reports survey of 1,947 adults conducted in April.

What can you do to make sure you’re not getting a drug you don’t need and to avoid harm?

Ten “secret shoppers” were sent to 45 drugstores across the US in a recent Consumer Reports investigative study. The shoppers were testing how well pharmacists identified potential problems with drugs.

Of course, it’s your doctor who should be your main consultant on the medicines you take. But bring a big measure of skepticism to your doctor visits: The evidence is now clear that they can be a part of the problem.

Based on the secret shoppers’ findings and more than a decade of Consumer Reports’ grant-funded Best Buy Drugs program, we have compiled a list of drugs that you should use special caution with when prescribed by your healthcare provider.

(For more detailed information, check out Consumer Reports’ September 2017 cover story and the physician-led Choosing Wisely program.

Abilify and Seroquel for Dementia or ADHD

These powerful antipsychotics have potent sedative effects and can be downright dangerous. Studies over the last decade show they have been overprescribed in general and particularly for elderly people with dementia.

The FDA and other healthcare and physician organizations now advise against their use entirely in elderly people. Multiple studies over many years have found an increased risk of death in elderly people prescribed these drugs.

Abilify (aripiprazole) and Seroquel (quetiapine) are also overprescribed to treat children and adults with attention-deficit/hyperactivity disorder (ADHD). The two drugs are not even approved for this condition. Their use to treat ADHD is not advisable unless a person is diagnosed with other psychiatric conditions, such as bipolar disorder. And even then, caution is warranted. Behavioral therapy is a better initial treatment for ADHD.

Advil, Aleve, Celebrex and Any Opioid for Back and/or Joint Pain

The non-steroidal anti-inflammatory drugs (NSAIDs) Advil (ibuprofen), Aleve (naproxen) and Celebrex (celecoxib) are commonly prescribed to treat back and joint pain (and headaches, of course). Short-term use — up to 10 days — is fine at the lowest dose that helps.

But long-term use — which is all too common — is ill-advised because all these drugs can cause bleeding in the intestines and stomach, and increase the risk of heart attack and stroke (especially at higher doses).

Opioids should simply never be a first-line treatment for either chronic back pain or garden-variety periodic back pain (“I threw my back out” kind of pain). The risks are too high. The side effects include drowsiness, sedation, nausea, vomiting, constipation, addiction and overdose. Instead, try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture or heat.

For intense pain flare-ups (pain in the range of 8 to 10 on a 10-point scale), an opioid can be useful, but it should be prescribed at the lowest dose that’s effective and for the shortest time possible, like a day or 2. And never more than a week to 10 days.

Celexa, Cymbalta, Lexapro and Prozac for Mild Depression

Antidepressants are overprescribed for people who have mild or so-called “situational” depression — that is, depression triggered by a life event such as a death in the family, job loss, divorce or breakup, accident, trauma or diagnosis with a serious health condition.

You don’t need a pill if these life events befall you. Social support, time and psychotherapy or counseling almost always help. Also, be sure to exercise and perhaps try meditation and/or yoga. For the vast majority of people who have situational depression, the symptoms lift within a few weeks to a couple months.

Nexium, Prevacid and Prilosec for Heartburn

These drugs, called proton-pump inhibitors (PPIs), reduce stomach acid. They were designed to treat a condition called gastroesophageal reflux disease (GERD). But they are greatly overprescribed for common, uncomplicated heartburn, which most of the time can be just as effectively treated with over-the-counter (OTC) products such as Maalox, Pepcid AC, Tums or Zantac 75.

The problem with taking PPIs is that they carry serious risks — a few of which were not fully appreciated until a few years ago. These include a reduction in the body’s ability to absorb certain nutrients and medications, along with an increased risk of gastrointestinal and other infections.

Instead, as a first-line treatment, eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid acidic or greasy meals that trigger heartburn.

If heartburn occurs twice weekly or more for 4 weeks or longer despite the above diet and lifestyle changes, then you might have damaged your esophagus. Check with your doctor, and if GERD is diagnosed, it would be appropriate to take a PPI for a few months while your esophagus heals.

Ambien, Belsomra and Lunesta for Insomnia

These strong sleeping pills are way overprescribed for people who have insomnia triggered by a life event, as well as for people who have chronic insomnia.

If you find yourself in the first group, try an OTC sleep aid containing an antihistamine, but not for longer than a few days. People with chronic insomnia are not helped in the long term by taking these medicines, recent evidence shows. Instead, try cognitive behavioral therapy (CBT), where a provider teaches you good sleep habits and suggests ways to change your behavior and nighttime habits.

Prescription medicines have significant side effects and risks, including dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

AndroGel, Axiron, Androderm and Aveed for Low Testosterone

Low testosterone (“low T”) is a controversial diagnosis. If you get such a diagnosis and your doctor advises you to take any of these medicines, get a second opinion.

A small percentage of men (usually in their 50s, 60s and 70s) have “low T,” but the manufacturers of these products have sought to create a condition that is not firmly established in medical literature — one marked by low energy and low sex drive due to “low testosterone.”

Don’t buy into it. The drugs can cause blood clots in the legs, sleep apnea, an enlarged prostate and possibly an increased risk of heart attack or stroke.

Instead, talk to your doctor about treating common underlying conditions that can decrease testosterone level, such as diabetes, obesity and aging. Also discuss non-drug ways to boost energy and vitality by exercising, getting enough sleep and couples therapy with your partner.

Actonel, Boniva and Fosamax to Treat Osteopenia (Low Bone Density)

These drugs, called bisphosphonates, are widely prescribed to treat a condition dubbed “pre-osteoporosis.” But there’s scientific controversy about the prevalence and impact of mildly or marginally low bone density, and whether it warrants treatment with these strong medicines.

All have side effects and carry risks, which include diarrhea, nausea, vomiting, heartburn, esophageal irritation and bone, joint or muscle pain. Long-term use has also been linked to an increased risk of fractures of the femur (thigh bone).

Before considering one of these medicines, walk more, quit smoking and try eating more foods high in calcium and vitamin D. If bone density tests show you have full-blown osteoporosis, you should consider one of these medicines. But use caution with long-term use.

Detrol and Oxytrol for “Overactive Bladder”

The sudden or frequent need to pee is frustrating and inconvenient. These medicines, called anticholinergics, are often prescribed even to people who have mild symptoms.

The drugs can cause constipation, blurred vision, dizziness and confusion. So before trying one, cut back on caffeine, soft drinks and alcohol, and watch your liquid intake overall. Also, try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises — repeatedly tightening and relaxing the muscles that stop urine flow. These techniques have been proven effective.

If several weeks or months of non-drug strategies don’t provide enough relief, consider an anticholinergic.

Actos and Glucophage for “Pre-diabetes”

Pre-diabetes is a widely accepted condition (unlike “low T”), but there’s no consensus on how aggressively to treat it, or if people with it should take drugs. People with pre-diabetes have blood glucose (sugar) levels at the high end of normal.

Because these diabetes medicines have side effects and carry risks — including dizziness, fatigue, muscle pain and, in rare cases, the dangerous buildup of lactic acid and a vitamin B12 deficiency — talk to your doctor about non-drug options first, such as exercise, a diet rich in unprocessed and non-starchy foods, and weight loss.

If you develop type 2 diabetes, however, you should consider a diabetes drug.

Drugs to treat Pre-hypertension

Like pre-diabetes, pre-hypertension is an accepted condition that warrants monitoring. It’s defined as blood pressure at the high end of normal. But, also like pre-diabetes, there’s no consensus on when to treat it with drugs.

Many classes of medicines are used. They include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers and diuretics. All are effective at lowering blood pressure but have side effects. Diuretics can cause frequent urination, low potassium levels and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums and, less often, breathing problems.

Unless a patient has other conditions that make the case for starting a drug, non-drug options are a better initial treatment to bring blood pressure into the normal range. Most important among them: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

Belviq, Contrave, Qsymia and Xenical for Obesity

These weight loss drgs have mixed effectiveness. They work for some people and not at all for others. For patients who are significantly overweight or have diabetes or heart disease, and have been unable to lose weight through exercise and diet, one of these medicines may be worth trying.

But the drugs should not be a first-line treatment for anyone who is just 10 to 20 pounds overweight and hasn’t yet really tried lifestyle and diet changes. All have side effects that are common and can be quite discomforting. Constipation, diarrhea, nausea and vomiting are common.

The drugs also carry rare but dangerous risks, including leaky heart valves with Belviq and liver damage with Xenical.

Americans are all too often pushed — or rushed — into taking drugs too soon. Sure, lifestyle changes can be hard. But they don’t have side effects and the risks are well defined and easily avoidable. And the payoff from adopting a much healthier diet or sticking to an exercise regimen often goes well beyond addressing the medical condition at hand and improves your overall physical and mental health.

Treating Neuropathy: Why Medications Are a Pain, and Some Alternatives for Relief

Patricia Braden liked hiking for hours in the woods and walking her Corgi-mix dog near her home in Greensboro, NC. The retired clinical psychologist also enjoyed long conversations with friends, family, and her clients.

But those days are over because of peripheral neuropathy and the side effects — such as problems with balance and concentration — of drugs used to treat it.

She is not alone. An estimated 20 million people in the US have some form of peripheral neuropathy, according to the National Institute of Neurological Disorders. The condition results from damage to the peripheral nervous system, the nerves running from the brain and spinal cord to the rest of the body.

Symptoms are numbness and a prickling or tingling sensation in your feet or hands, which can spread to the legs and arms. Other signs include sharp, throbbing, freezing or burning pain, extreme sensitivity to touch, and a lack of coordination that can lead to falls.

Drugs Used to Treat Neuropathy

The drugs to treat neuropathy fall into 2 classifications: antidepressants and anti-seizure medications, though it is not totally clear why they work for nerve pain. Many patients also experience a host of sometimes debilitating side effects from the drugs. The good news is that there are several alternative treatments and therapies that many patients have used to find relief that can minimize the use of medications.

David Cornblath, MD, professor of neurology at Johns Hopkins Hospital in Baltimore and a specialist in peripheral neuropathy, said the 3 main drugs approved for treating diabetic neuropathy — the most common type of neuropathy — “all have positives and negatives.”

He said the anti-seizure medication Neurontin (gabapentin) has the fewest side effects. Lyrica (pregabalin, another anti-seizure medication) comes next, and the antidepressant Cymbalta (duloxetine, a serotonin and norepinephrine reuptake inhibitor) has the most.

Doctors prescribe those same drugs for other kinds of neuropathy, such as the category of idiopathic neuropathy (meaning no known cause) into which Braden and many others fall. They are also used for fibromyalgia, another nervous system disorder with some of the same symptoms as neuropathy.

According to Cornblath, “Many start with gabapentin. It’s well-tolerated. But relief rarely occurs until people get to 1,800 milligrams a day,” he said. “Many are underdosed.”

However, “many patients find the side effects of increased dosages intolerable,” said Marlene Dodinval, executive director of The Foundation for Peripheral Neuropathy, a nonprofit in Buffalo Grove, IL.

Common side effects of the 3 drugs include fatigue, nausea, drowsiness and confusion, and weight gain or loss, in addition to side effects specific to each drug and the possibility of drug interactions. But they can be more extreme: The FDA requires manufacturers of antiepileptic drugs to carry warnings about increased risks of suicidal thoughts and behaviors. Antidepressants may also increase suicidality, especially for children, young adults and teenagers. In trials, patients who took an antiepileptic drug had almost twice the risk of suicidality as those who did not.

Falls, Forgetfulness and Other Side Effects

The 83-year-old Braden has not been immune from side effects. “I’ve fallen 3 dozen times in the last 10 years.” To help alleviate the sharp pain and the sensation that she likened to wearing iron shoes, her doctor put her on a high dose of Neurontin, which made her forget words in the middle of a thought, as did the Cymbalta that she takes.

“The thing I struggle with is, I don’t know if the benefit is worth the side effects,” she said.

Others have a similar dilemma. Valerie Lloyd, a retired government employee, could take more Neurontin for her painful chemotherapy-induced peripheral neuropathy, but is deterred by the side effects. “It’s in my feet, hands, and sometimes lips,” she said. “I feel OK in the morning, and that’s when I shop and garden. By about 6 in the evening, I get a burning, electrical feeling, the pins and needles.”

Lloyd started on three 300mg capsules of Neurontin a day, working up to 4 and 5 capsules daily.

“My doctor said I could take 6, but the thought of taking more turns me off. I didn’t like the way it made my feet feel swollen and fat,” she said. “I stopped taking it and it was a different kind of pain, so I went back” on Neurontin.

Alternatives to Medication for Nerve Pain

However, medications aren’t the only way to treat nerve pain. Lloyd, a 65-year-old Alexandria, VA, resident, said she has found some relief in a foot cream whose main ingredient is capsaicin, a substance found in hot peppers, and thought to reduce chronic neuropathic pain by making nerves less sensitive to pain messages.

Water aerobics also help her “feel a little better about my strength and definitely helps my state of mind.”

This approach is consistent with a slew of mind and body therapies and other complementary and integrative therapies, according to The Foundation for Peripheral Neuropathy.

Carolyn Hicks, a psychologist and landscape painter in Northampton, MA, found relief in one such therapy — acupuncture — when the 70-year-old got peripheral neuropathy after chemotherapy for breast cancer. “I found that it was very helpful having more energy and balance and also in mitigating symptoms associated with neuropathy such as numbness and tingling, aches and sensitivity to the cold, and burning in fingers and toes,” she wrote in an email.

Elayne Goldstein, a 68-year-old retired teacher from Philadelphia, developed numbness and pain “like a knife was slicing my foot” after a knee replacement 2 years ago. She was on a high dose of Neurontin but weaned herself down to 300mg at night “because I didn’t want to be on medication.”

At night she wears a magnetic wrap “because something compressing it seems to help.” She also teaches yoga dance to seniors. “When I’m moving, I don’t feel any pain.”

Jennifer Buttaccio, an occupational therapist in Chicago, advises patients on better managing daily activities, strengthening exercises, and pain management strategies to find relief.

“I can recommend a patient talk to their doctor about having their vitamin B12 and magnesium levels checked,” she said. “I can also tell them to see if the doctor will provide them with a script for physical therapy to see if there are more specific modalities, strengthening, and pain management strategies that can be implemented.”

A Man’s Guide to Overactive Bladder

They are problems that many men don’t want to talk about out of potential embarrassment. Still, many men have to contend with overactive bladder and urinary incontinence — in layman’s terms, when control over urination is lost — which can be an indication of bigger problems. Just as important, it can lead to emotional issues and impact a man’s social life.

There are treatment options available for the condition, though many doctors will first turn to prescription medication, especially if the leakage is the result of an overactive bladder. Drugs such as Ditropan XL (oxybutynin), Detrol (tolterodine), VESIcare (solifenacin), Avodart (dutasteride) and Flomax (tamsulosin) are just some of the ones used. But did you known that there are a host of side effects that are associated with them?

If taking medication doesn’t sound like a great prospect to you and the possibility of wearing pads makes you anxious, don’t panic. The good news is there are plenty of non-pharmacological treatments available that have good outcomes with fewer side effects. One of them is even a simple exercise you can do at home. (More on that later.)

But before we get into treatments, let’s start with a primer on urinary incontinence and what could put you at risk for suffering from it.

How Common Is Urinary Incontinence?

Losing bladder control doesn’t commonly occur in younger men, but if you’re an older man — especially over the age of 60 — your chances of developing urinary incontinence increases  (odds around 11-34%) due to associated prostate issues. The National Institutes of Health reports that between 11% and 34% of older men experience incontinence at least occasionally and 2-11% report it is a problem daily.

It can affect your everyday life because if you strain physically, or even sneeze or cough, you could find yourself with leakage in your pants. As a result, you might stop doing things you enjoy, such as socializing or sporting activities. Even sexual encounters can be affected, as position and pressure during intercourse can cause bladder spasm or leakage.

Types of Urinary Incontinence

Urgency incontinence, also known as overactive bladder, is involuntary urination or a very strong desire or urgency to urinate.

Stress incontinence is a weakness of the bladder or sphincter muscles.

Overflow incontinence, also known as after-dribble, is a consequence of not emptying the bladder properly.

Functional incontinence happens when you know you need to urinate, but due to mental or physical reasons, such as dementia or impaired mobility, cannot make it to the bathroom in time.

Risk Factors for Men

Men with certain health conditions or medical histories are at a higher risk of developing incontinence. Not surprisingly, having any kind of prostate problem greatly increases the chances of having incontinence. This includes having a prostatectomy, a procedure involving the partial or complete removal of the prostate due to prostate cancer.

In addition, radiotherapy, a type of treatment for prostate cancer, can also lead to incontinence. Any irregularities with your urinary tract are also a potential cause.

If you are overweight, you are also at a higher risk. All that extra weight is putting extra pressure on the muscles around the pelvis, weakening them. This can then lead to accidental urine leakage.

Neurological conditions that influence the brain or spine can also spur incontinence. Alzheimer’s disease, multiple sclerosis, Parkinson’s disease and stroke can damage the brain’s ability to control certain functions well, such as urination. If this happens, it is known as neurogenic bladder.

Testing

Male incontinence is usually diagnosed after taking a medical history and conducting a physical exam.

“Usually a urinalysis is performed and, depending on the findings of the history and physical, further testing with either x-ray studies or an urodynamics study may be appropriate,” says Karl Kreder, MD, a urologist with the University of Iowa Hospital and Clinics. Urodynamics testing can determine bladder flow, capacity and function.

Other potential tests include a cystometrogram, which measures the bladder’s ability to store and expel urine, or an electromyogram, which looks at the electrical activity of muscles around the bladder.

In some cases, a cystoscopy might be warranted. This test allows a doctor to see inside your urinary tract and can detect if the neck of the bladder is contracted.

Dealing with Overflow Incontinence (aka After-Dribble)

After-dribble/overflow incontinence is where a small amount of urine leaks out after you’ve finished.

The good news is that this type of incontinence responds well to self-treatment. Here are some tips:

  • Sit down on the toilet to empty your bladder.
  • Make sure elatics, belts or briefs are not tight around your penis and scrotum to ensure the urethra is straightened when urinating.
  • Alternatively, place your fingertips behind the scrotum and apply gentle upward and forward pressure to encourage urine flow.

Medications for Urinary Incontinence

If your problem is overactive bladder, a medical professional will likely prescribe you anticholinergic/antispasmodic medications such as Ditropan XL, Detrol, Enablex (darifenacin), VESIcare, Sanctura (trospium) and Toviaz (fesoterodine). The most common side effects of these are dry mouth, blurred vision, constipation, nausea, dizziness, drowsiness and joint pain.

Avodart and Proscar (finasteride), known as 5-alpha reductase inhibitors, are also commonly prescribed for overactive bladder. However, they are associated with sexual side effects, such as erectile dysfunction. A recent study also found that men on Avodart had a higher risk of developing diabetes and high cholesterol compared to those taking another overactive bladder drug, Flomax, which is known as an alpha blocker.

Although an older class, many doctors look to alpha blockers (alfuzosin, doxazosin, prazosin, silodosin, terazosin) as an initial treatment. However, side effects with them include dizziness, headache, stomach problems and reduced semen during ejaculation.

For stress incontinence, you may be prescribed a tricyclic antidepressant such as Tofranil (imipramine) and Elavil (amitriptyline); or selective serotonin reuptake inhibitors (SSRIs) such as Cymbalta (duloxetine). Antidepressants come with some nasty side effects, from constipation to vomiting, weight changes and decreased sex drive.

Alpha-adrenergic agonists are another option and include ProAmatine (midodrine) and Sudafed (pseudoephedrine), which is available over the counter. Common side effects include loss of appetite, insomnia and skin rashes or itching.

Many men with urinary incontinence or overactive bladder turn to medications first, but there are several non-pharmacological interventions available that have fewer side effects.

Although it is best known for its ability to reduce wrinkles, Botox (onabotulinumtoxinA) is also approved to treat overactive bladder with symptoms of urge incontinence. This is because Botox is actually a muscle relaxant.

Alex Shteynshlyuger, MD, a urologist with New York Urology Specialists, says that Botox may be a good treatment option for people who have failed after trying other drugs. He mentioned one study that found that patients who didn’t benefit or couldn’t tolerate oral medications had an average of 5 urinary leakage episodes daily. After Botox, they experienced just 2 episodes a day.

“For most patients, one procedure will last over 6 months, and may even last the full year,” Shteynshlyuger says.

Glutaraldehyde — a collagen-like substance — is an FDA-approved medication that gets injected into the sphincter via a tube inserted in the urethra at 4 sites to bulk it up and decrease leakage. The short-term success rate is good but treatments need to be repeated, which most men find off-putting. Injectables have a 42% dryness rate and a 13% complication rate. This complication typically involves being unable to empty the bladder completely or urinary tract infections.

All the above medications can have more severe side effects, which is why you may want to explore alternative options.

Alternative Treatments

Pelvic floor exercises, also known as Kegel exercises, involve performing contractions of the urethral sphincter muscle several times a day over a period of at least 3 months. These exercises are easy to do, are the most effective way to regain control over your bladder, and are effective for all types of incontinence except after-dribble.

Kegel exercises have also been shown to hasten the time it takes to regain control after prostatectomy surgery, with 55% fewer leakage episodes compared to men who don’t perform the exercises.

To perform the exercises, imagine you’re urinating and want to stop the flow; you squeeze your internal muscle to stop mid-flow.

You’re simply contracting and relaxing the muscles that control urination, in order to strengthen them, and can perform the exercises while lying down, sitting at a desk or standing up. The contractions should be performed several times per day for at least a few months to see if they have any effect.

“Kegel exercises will benefit patients with stress or urge incontinence and are very worthwhile treatments as they have virtually no side effects and a relatively high degree of success,” adds Dr. Kreder.

The video below explains how to perform these exercises in more detail.

Volume-adjustable balloons provide another possible solution. These balloons are placed at the bladder neck and can be air-adjusted, providing an average 50% dryness in those using them.

In recent years, male slings have become increasingly popular for treatment of urinary incontinence because they are highly effective (around 84-92% dryness) and have a high satisfaction rate as well (4.5 on a 5-point scale). A sling is a surgical procedure that suspends synthetic threads above the rectum and under the urethra to provide extra support and relieve pressure. Slings, however, are not appropriate for after-dribble.

There are several types of slings available for men, including the bone anchored sling (BAS), rectourethral transobturator sling (RTS), adjustable retropubic sling (ARS) and quadratic sling. They also come in adjustable and unadjustable. Slings are appropriate for all types of incontinence, except for after-dribble.

If the problem is sphincter malfunction, you can undergo surgery to have an artificial urethral sphincter implanted. Men treated by this method were shown to have an 82% dryness rate and a 23% complication rate, which can be infection, erosion of the cuff or mechanical failure.

The bottom line: If you do find yourself having bladder issues, don’t be embarrassed to seek help.

For Back Pain, Try Non-Drug Measures First

Back pain is the most common kind of chronic pain. It’s also a near-ubiquitous form of acute, short-lived pain after a minor injury, a bit too much exercise, lifting something the wrong way, a stressful day at the computer or an encounter with a bad bed.

In one survey, a quarter of adults reported having low back pain lasting at least one day in the past 3 months. But over the long term, we all fall victim.

For decades, the prevalent response to a bout of back pain — acute or chronic — was to reach for the pill bottle. Over-the-counter pain relievers mostly, like Advil (ibuprofen), Aleve (naproxen) or Tylenol (acetaminophen).

But in recent years, more and more people with back pain have been prescribed opioid painkillers. At the same time, doctors have sharply escalated their use of CT and MRI scans for people with back pain. A 2013 study of back pain treatment in JAMA Internal Medicine, for example, found that between 1999 and 2010 prescriptions for powerful narcotic pain meds increased by 51%, the use of CT and MRI scans jumped by 57%, and referrals to surgeons, neurologists and other specialists more than doubled.

As a result, public health authorities, physician groups and pain management experts are taking serious aim at the overuse of narcotic painkillers and imaging tests in people with back pain.

Non-Drug Measures for Back Pain Relief

New treatment guidelines strongly recommend that people with back pain first try non-drug measures such as yoga, physical therapy, chiropractic and massage before resorting to over-the-counter or prescription pain relievers.

The guidelines come from a team of experts convened by the American College of Physicians. They were published in February in the Annals of Internal Medicine. The expert group — comprised of leading back pain specialists and front-line docs — evaluated 46 recent studies on back pain and medications and 114 studies of non-drug approaches.

In addition to the above-mentioned interventions, the group recommended first trying the following before resorting to drugs: exercise, tai chi, acupuncture, mindfulness-based stress reduction, progressive relaxation, biofeedback and cognitive behavioral therapy.

Importantly, the researchers found no evidence that any of these techniques is better than any other; it’s a matter of personal preference and what works for your pain and in your life.

New guidelines call for trying alternative methods such exercise, acupuncture, yoga, tai chi and mindfulness stress reduction to reduce pain before resorting to drugs.

What If Alternative Methods Don’t Provide Enough Relief?

If the source of the pain is an acute injury (that is, it’s of sudden onset and has lasted less than a few weeks), try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) first. Ibuprofen works as well as the others for most people, and is inexpensive. Naproxen is another alternative.

If the pain is particularly bad — preventing you from working, sleeping or functioning normally — you can also try a muscle relaxant. But limit the use of it to a week at most. Muscle relaxants like Flexeril cause drowsiness and sedation and can be habit forming.

Based on the latest research, the group concluded that acetaminophen is not effective for acute back pain, especially if the pain is related to an injury that causes inflammation. Unlike the NSAID drugs, acetaminophen does not reduce inflammation.

The expert guidelines also advise against steroid injections, citing the lack of evidence that this approach is helpful.

Try NSAIDs First If Non-Drug Techniques Fail

If you have chronic back pain and non-drug techniques don’t provide relief within a week or two, the guidelines recommend NSAIDs as the first-line therapy. If they don’t do the job, talk with your doctor about tramadol, Cymbalta (duloxetine) or a muscle relaxant.

Tramadol is a low-strength opioid with less risk of side effects, abuse and addiction. Duloxetine is an antidepressant proven effective against some kinds of pain.

About other, stronger opioids, the new guidelines say: “Clinicians should only consider opioids as an option in patients who have failed [other] treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

Indeed, the back pain experts emphasize that opioids have not been shown to relieve chronic back pain over the long term without significant risk. Namely, too many people end up taking higher doses to get the same pain relief. As a result, they put themselves at higher risk of addiction and its well-known adverse consequences.

A recent meta-analysis in JAMA Internal Medicine that included 20 trials involving 7,300 patients found that opioids didn’t provide significant relief for people with chronic back pain. Further, half the participants dropped out early because the medication didn’t work or the side effects were intolerable.

In contrast, a survey of 3,562 adults by Consumer Reports found that almost 90% of people who tried yoga or tai chi said these practices were helpful against back pain, and about 80% said the same of massage and chiropractic. Even so, about a third of respondents said they took prescription drugs for their back pain, and of those, 57% were prescribed opioids at some point.

“Many physicians who are used to writing prescriptions right off the bat or sending patients for tests are going to have to rethink the way they manage back pain,” says Nitin S. Damle, M.D., former president of the American College of Physicians.

Consumer Reports’ June 2017 cover story is on back pain and draws on the new guidelines, its survey and recent research.

Among the tips from the ACP guidelines and Consumer Reports:

Avoid bed rest; that’s outdated medical advice. Gentle activity such as walking and light stretching, and generally staying active, is more helpful.

You don’t need to see a doctor if your back injury is minor. The vast majority of injuries and tweaks of the back heal on their own. But be patient. It may take a week or 2 or even 3 in some cases. If the pain worsens over time or fails to ease, do see a doctor.

If your pain is radiating down one leg, see a doctor. This can indicate that a nerve is involved.

Be judicious with how much ibuprofen and naproxen you take. Don’t exceed 1,600 milligrams (8 200mg pills) of ibuprofen a day or 1,000mg of naproxen a day. Limit use of both to 7 days. They both carry risks if taken at high doses for long periods.

Personalize your treatment plan. Everyone responds to pain differently, and there’s no set strategy for treating back pain that works for everyone.

✔ The National Center for Complementary and Integrative Health, or NCCIH, can recommend a practitioner. The UCLA Mindful Awareness Research Center offers free online mindfulness and relaxation programs. And if you decide to try acupuncture, check that your practitioner is certified by the National Certification Commission for Acupuncture and Oriental Medicine.

Do Your Psychiatric Drugs Keep You Up at Night?

If you take a medication for a psychiatric condition, you may have experienced troubled sleep — insomnia, daytime sleepiness, or any other numbers of sleep-related disorders. I have treated patients with myriad sleep difficulties who take antidepressants, antipsychotics and even medications to treat attention deficit/hyperactivity disorder (ADHD).

While no one wants to experience a poor night of sleep, it’s important to recognize whether the sleep problem you are having is a result of a side effect of a drug (or drugs) you are taking, or something completely independent of medication. That is why if you are on psychiatric medication – or any drug for that matter – and you find yourself having difficulty catching some Zs, it’s important to talk to your primary doctor, who may change your medication or refer you to a sleep specialist for further evaluation. In many cases, the benefits of a drug may outweigh the sleep-deficit side effects. Your physician can work with you to minimize the impact of them.

However, it’s a good idea to know what some of the sleep-related side effects are that have been reported with different types of drugs which act upon the brain. Let’s start with antidepressants. The most commonly prescribed ones are known as SSRIs (selective serotonin reuptake inhibitors) and have names including Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). Complaints of both insomnia and daytime sleepiness have been reported in patients with depression on SSRIs. Prozac’s impact on sleep has been the most widely studied. Interestingly, it has been shown to have both a sedating and energizing effect depending on the individual. Prozac can also cause decreased sleep efficiency, awakenings during the night, and interrupted REM (rapid eye movement) sleep, an important period during the sleep cycle that allows a person to dream vividly.

Antidepressants and Vivid Dreams

Another class of antidepressants, SNRIs (serotonin norepinephrine reuptake inhibitors), are known to cause sleep problems similar to those in SSRIs, as well as vivid dreams. Common SNRIs are Effexor (venlafaxine), Pristiq (desvenlafaxine) and Cymbalta (duloxetine).

Treatment with Effexor has also been associated with a condition known as dyskinesia that is characterized by occasional movement of one’s limbs, repetitive and involuntary movements of the extremities – typically the legs – usually during or just before falling asleep. There have also been cases where these involuntary movements have been seen a week after a person stopped taking Effexor.

One antidepressant, Wellbutrin (bupropion), has been associated with insomnia. However, studies that have examined electrical activity of the brain in patients taking bupropion indicate the drug actually increases REM sleep time.

It’s important to recognize whether the sleep problem you are having is a result of a side effect of a drug (or drugs) you are taking, or something completely independent of medication.

Antipsychotics are usually prescribed for schizophrenia and other psychotic disorders, though they are also prescribed for bipolar disorder and to supplement antidepressants in the treatment of depression. One of the most popular antipsychotics, Seroquel (quetiapine), has been associated with faster sleep onset and longer overall sleep time. A typical antipsychotic, Clozaril (clozapine) has also been associated with improving sleep onset and sleep time.

RLS (restless legs syndrome) can ruin a good night’s sleep and antipsychotics and antidepressants have been known to lead to cause it. The strong urge that RLS causes to uncontrollably move one’s legs can make it hard to sleep, lead to sleeplessness, irritability and depressed mood. Remeron (mirtazapine), an older, atypical antidepressant, is most likely to cause RLS. A case study found that RLS appeared to be provoked in patients on a low-dose of Seroquel. Interestingly, some evidence has shown that Wellbutrin may actually help to alleviate RLS.

Lifestyle Changes May Help Curb Sleep-Related Side Effects

However, you might find relief from RLS through lifestyle changes and/or taking certain vitamins. For example, going to the bed at the same time every night and getting up at the same time each morning can help. Also, there are some indications that a lack of some vitamins and minerals, such as iron, folic acid, magnesium, and vitamin B, can contribute to RLS.

Not surprisingly, insomnia and delayed sleep onset are associated with stimulants such as Adderall and Ritalin (methylphenidate), that are used in the treatment of ADHD. However, the effect of Ritalin on sleep may depend on the amount of time a child has been on the drug and when the medication is given. There have also been reports of children having difficulty falling asleep as they are being weaned off the medication.

Sleep is an important part of staying healthy and feeling good. Again, if you feel you are experiencing sleep issues as a result of medication, speak to your doctor without delay. Sleep-related side effects due to drugs impact relatively few patients. And if it ends up your sleep problems are not drug-related, the good news is there are steps you can take to rectify the situation. Changes in sleep hygiene and even in your bedroom environment can provide some of the most effective improvements, as can making sure you are getting enough sleep in the first place. As we are in the middle of Sleep Awareness Week, I recommend visiting the National Sleep Foundation’s website for more helpful tips.

This piece is based on an article, Adverse Effects of Psychotropic Medications on Sleep, published in the journal Psychiatric Clinics of North America in 2016.

Women: How to Deal With Urinary Incontinence Without the Meds

No woman wants to be caught too far from a bathroom, especially when the ability to hold your bladder is a struggle. But if it gets to the point where the thought of coughing or laughing leads to leakage anxiety, or you have to wear pads due to wetting your panties, well, it’s natural to have a few concerns.

Unfortunately, urinary incontinence is yet another health condition that affects more women than men: 25-45% of women aged 30 to 60 years, and 7-39% of women aged 20 to 30 years suffer from the condition. It can be a very embarrassing issue that can affect your self-esteem, confidence and quality of life.

Fortunately, for many women a few adjustments in diet and some exercises will significantly decrease minor incontinence problems.

Even though bladder concerns are an embarrassing issue, don’t be afraid to reach out for help, because, thankfully, there are a range of different treatments that can remedy the problem. So let’s have a grown-up talk about your options.

Types of Urinary Incontinence

There are two main types of urinary incontinence in women — stress urinary incontinence and overactive bladder, also known as urgency incontinence. Many women can experience both types at the same time.

Stress incontinence is characterized by urine leakage due to pressure, coughing, sneezing, laughing or physical activity. This is triggered by physical changes to the pelvic region and weakening of the supporting muscles or weakening of the urethra wall.

Overactive bladder is a strong desire or urgency to urinate that may result in unexpected urination or leakage of urine. This urgency is often triggered by involuntary bladder spasms that occur due to abnormal nerve signals to the bladder from the brain.

Causes of Urinary Incontinence

There are a range of causes in women, including:

  • Urinary tract development problems from childhood
  • Genetics: If other female family members have it, you’re more likely to
  • Ethnicity: Caucasian women are more afflicted than other ethnicities
  • Childbirth and/or pregnancy can damage the muscles and nerves that control urination
  • Menopause: There is a reduction in hormones that keep the urethra and bladder lining strong and healthy
  • Pelvic organ prolapse: The bladder, bowel or uterus sag and shift from their normal positions
  • Neurological problems
  • Lack of exercise
  • Overweight or obesity
  • Older age

Diagnosis

For a diagnosis, you can visit your general practitioner, gynecologist, urologist or a urogynecologist. They will take your medical history, conduct a full physical examination, which includes a pelvic and rectal exam, and will order a range of diagnostic tests such as a urinalysis (standard urine test), urine culture (to test for urinary tract infection), blood test (to assess kidney function or chemical imbalances) and urodynamic testing (to determine bladder flow, capacity and function).

Once they diagnose the issue, they will may prescribe one in a range of medications.

Exercises and Minor Lifestyle Adjustments

If you want to avoid taking meds to deal with incontinence, lifestyle changes are a good place to start and include:

  • Limit bladder irritants — coffee, tea, carbonated beverages, alcohol, tomatoes, spices, chocolate, citrus and high-acid foods
  • Limit water at least 3 hours before bed
  • Lose weight
  • Treat constipation
  • Engage in bladder training, using distraction/deep breathing techniques to help retrain nerve signals and suppress urgency sensations; or retraining of the bladder with scheduled visits to the toilet.

The pelvic floor muscles support the uterus, bladder and bowel in women. And according to research, strengthening these muscles via Kegel exercises is one of the best ways to regain control.

You don’t need any special equipment to perform Kegel exercises. And the best news is, you can perform them anytime — at work, on the train, or in line at the supermarket — because no one will ever know.

To perform the exercises, imagine you’re urinating and want to stop the flow; you squeeze your internal muscle up tight to stop mid-flow.

You’re simply contracting and relaxing the muscles that control urination, in order to strengthen them, and can perform the the exercises while lying down, sitting at a desk or standing up. The contractions should be performed several times per day for at least a few months to see if they have any effect.

Here’s a short video that explains how to do the exercises in more detail.

Medical Devices

It can be difficult for some women to contract the pelvic floor muscles, so vaginal cones are often used. A vaginal cone is a small medical device that’s inserted into the vagina like a tampon. The device acts as an internal weight-training tool for you to squeeze around. As your pelvic floor muscles become stronger, you can increase the weight of the vaginal cone to strengthen the muscles even further.

If leakage continues to be bothersome, you may prefer to use a urethral insert, which is a tampon-like disposable device. It’s inserted into the vagina to prevent leakage and removed when you need to urinate. Another option is a pessary, a ringed device that presses against the urethra to decrease leakage.

Electrical Stimulation

Some electrotherapies such as electroacupuncture and electro current to the pelvic floor muscles show improvement in some women.

Medications

If your problem is overactive bladder, a medical professional will likely prescribe you anticholinergic/antispasmodic medications such as Ditropan XL (oxybutynin), Detrol (tolterodine), Enablex (darifenacin), VESIcare (solifenacin), Sanctura (trospium) and Toviaz (fesoterodine). The most common side effects of these are dry mouth, blurred vision, constipation, nausea, dizziness, drowsiness and joint pain — none of which are pleasant.

For stress incontinence, you may be prescribed a tricyclic antidepressant such as Tofranil (imipramine) and Elavil (amitriptyline); or selective serotonin reuptake inhibitors (SSRIs) such as Cymbalta (duloxetine). Antidepressants come with some nasty side effects, from constipation to vomiting, weight changes and decreased sex drive.

Alpha-adrenergic agonists are another prescription option and include ProAmatine (midodrine) and Sudafed (pseudoephedrine), with common side effects such as loss of appetite, insomnia and skin rashes or itching.

All the above medications can have more severe side effects also, which is why you may want to explore alternative options.

Surgery

As a last resort, you may opt for surgical intervention. Research shows 73-83% of women are more than satisfied with the results of these surgical procedures.

Retropubic suspension involves surgical insertion of synthetic threads to lift up the bladder neck and urethra for additional support. Internal slings are another option and involve insertion of a man-made sling to cradle the bladder neck and urethra.

The most important thing is, don’t let your urinary incontinence go unchecked. Yes, it is an embarrassing thing to talk about, but we are all grown-ups here.

What Is Irritable Bowel Syndrome and How Best to Treat It?

Irritable bowel syndrome (IBS) is a real pain. You can have difficulty going to the toilet, which gives you a buildup of pain and discomfort in your gut. Or, you need to stay close to the toilet because you can’t contain your bowels when you get the urge.

Either way, it’s an incredibly unpleasant situation.

Ten to 15% of adults and an estimated 6% to 14% of children suffer from IBS. The symptoms can severely impact quality of life, so much so that the condition has been linked to suicidal behavior. That’s why it’s important to know that IBS is considered a real medical condition. And just as crucial, there is help out there for you.

Numerous medications are used to treat the unpleasant condition, but all have side effects you should be aware of. They can be as minor as dizziness and drowsiness, or as severe as muscle cramps, tremor and weight gain. You can find out more below about IBS and the best ways to treat it.

What is IBS?

IBS is termed a “functional gastrointestinal (GI) disorder.” This means that compared to average, the GI tract of people with IBS works more slowly, quickly or differently.

What causes IBS?

The cause is often due to many reasons and can be the result of GI hypersensitivity, small intestinal bacterial growth, psychosocial factors, increased intestinal inflammation and dysregulated communication between the gut and the brain.

What are the symptoms of IBS?

Symptoms include abdominal pain and discomfort, bloating, constipation, diarrhea or both, along with altered bowel function such as frequency, incomplete evacuation, and frequent changes hard/loose stool alteration.

What are the treatment options for IBS?

“I treat a lot of IBS sufferers, and it’s an illness that is quite difficult to treat,” says Jordan Tishler a Harvard-trained physician who focuses on holistic care. Generally, Dr. Tishler recommends a variety of approaches including medications, diet and alternative treatments. “They seem to work additively, [with] some approaches working better for some people than for others.”

Additional fiber is frequently recommended for IBS patients. Though, while “bulk-forming laxatives, like Metamucil, can be quite helpful, even for diarrhea-predominant IBS, they can also provoke gas and bloating,” notes Dr. Tishler.

Registered dietitian Ryan Whitcomb suggests that some individuals may experience additional relief with “galactooligosaccharide (GOS), a prebiotic that may improve stool consistency, flatulence, bloating and overall IBS symptoms.” It is available as a dietary supplement.

Common Medications Used to Treat IBS and their Side Effects

In terms of side effects, “all medicines have them, they come with the territory. However, we must remember that most people do NOT get side effects, or at least not badly enough to stop using the medication,” says Dr. Tishler. “That said, medications need to be viewed as a risk/benefit situation, and trying them with your eyes open and taking stock of their benefit after a while is the best plan.”

NameBrandsTypeOTC/RXSide effects
HyoscyamineLevsin, Levbid and 25 other brand namesAntispasmodicRXDry mouth, dizziness, blurred vision, nausea, drowsiness, weakness, and nervousness.
DicyclomineBentyl, TriacetinAntispasmodicRX
LoperamideImodium, Pepto Diarrhea Control, DiamodeAntidiarrhealOTCDry mouth, dizziness and drowsiness.
Diphenoxylate/ AtropineLomotil, Lonox, Vi-Atro, LomocotAntidiarrhealRXBlurred vision, confusion, difficult urination, dry mouth, fever, headache and potentially addictive. Side effects after ceasing meds – sweating, muscle cramps, nausea, trembling and stomach cramps.
Amitriptyline/ desipramineVanatrip, Elavil, Endep / NorpraminTricyclic antidepressantsRXTachycardia, dizziness, nervousness, sedation, tremor and weight gain.
DuloxetineCymbaltaSSRI antidepressantRXInsomnia, dizziness, weakness, drowsiness, diarrhea, constipation, headache.
XifaxanRifaximinAntibioticRXFlatulence, headache, nausea, abdominal pain, bowel urgency.

Newer medications, such as Lotronex (alosetron), Viberzi (eluxadoline), Amitiza (lubiprostone) and Linzess (Linaclotide), have been approved specifically to treat IBS or relate symptoms, but they also have side effects to be aware of. Lotronex has a “black box” warning about the risk of serious gastrointestinal adverse reactions, including colitis and severe complications from constipation. Use of Viberzi can lead to pancreatitis and a muscle spasm in the digestive system.  Amitiza can cause nausea, diarrhea and abdominal pain. And Linzess should be not be taken by those under 18.

Dietary Options

Anti-Inflammatory Diet

“Food is a big IBS trigger, and it’s vital to address diet,” says Whitcomb. “When food is the cause of the symptoms, nothing will relieve the symptoms until the foods are identified and subsequently removed.”

Whitcomb suggests that removing inflammatory foods resolves most, if not all, IBS-related symptoms within a matter of weeks. “I use the MRT [mediator release testing] blood test which looks at 120 foods and 30 food chemicals and reports which foods the patient’s immune system is overreacting to, causing inflammation, pain and digestive issues,” he says. “Once we identify these foods, we remove them from the diet and add in the foods we know they are not reactive to.”

Low FODMAP Diet

FODMAPs refer to a group of carbohydrates that may trigger IBS symptoms due to poor absorption in the small intestine, which then leads to increased fermentation in the GI tract. Therefore, eliminating FODMAP foods provides relief.

The low FODMAP diet has been shown to be effective in reducing symptoms in 70%-86% of participants in scientific studies.

Alternative Treatments

Probiotics

Probiotics (Bifidobacterium infantis 35624 and Lactobacillus plantarum 299V) help manipulate the types of bacteria in the gut, which subsequently relieves pain, discomfort, bloating and constipation. Probiotics (Bifidobacterium infantis M-63, breve M-16V and longum BB536) are particularly beneficial in children where other forms of treatment have no benefit. If you want to get more probiotics in your diet naturally, seek out yogurt.

Herbal Medicine

Peppermint oil in capsule form taken 3 times a day 15-30 minutes before meals may help  improve abdominal discomfort, bloating and overall symptoms. However, it can cause heartburn in some people.

Ginger and ginger extract may help reduce nausea, decrease inflammation, strengthen the gut lining and stimulate bowel function.

St. John’s wort may help relieve stress-related symptoms associated with IBS.

Homeopathic remedies

The only homeopathic remedy with some evidence) of benefits is asafoetida, an herb with a pungent smell.

Cannabis

Dr. Tishler, an expert on cannabis therapeutics, suggests the only therapy he has found to be highly effective is marijuana.

“Cannabis used once daily at bedtime can control symptoms without the side effects produced by laxatives or antidiarrheal medication like Imodium,” he says. “Of course, cannabis has some side effects as well, like intoxication or dry mouth. Though, with care, these side effects can be managed and IBS patients do very well.”

Antidepressants Show No Effect on Children and Teens

Although antidepressants are prescribed to millions of children and adolescents, the drugs do not offer any clear benefit to them and can boost the risk of suicide among users.

That’s the consensus of a new analysis published in the British medical journal The Lancet, which examined the results of 34 trials that included 5260 children and teens and 14 antidepressants.

And the researchers’ main conclusion: “When considering the risk–benefit profile of antidepressants in the acute treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents.”

Among all the antidepressants examined, only Prozac (fluoxetine), one of the first SSRIs (selective serotonin reuptake inhibitors) to hit the market, was found to be effective in this population, albeit the effect was rather modest.

Perhaps the most disturbing results from the meta-analysis had to do with side effects associated with the drugs. People on antidepressants are at risk for an array of side effects, including weight gain, anxiety and decreased sex drive.

The most severe side effects occurred with Effexor (venlafaxine), which was linked to an increased risk of suicide compared to placebo and 5 other antidepressants. Since 2004, the FDA has mandated that a “black box” warning – the most severe issued by the agency – be placed on the labeling for antidepressants noting the risk of suicide in young people associated with the drugs.

Patients who were given Effexor, Cymbalta (duloxetine) and Tofranil (imipramine) were more likely to quit taking the medications because they couldn’t stand the side effects compared to those taking a placebo.

The frequency of side effects may actually have been under-reported since, as the authors noted, many of the studies included in the meta-analysis were funded by pharmaceutical companies, which have been known to use poorly designed trials as well as selective disclosure of results.

Jon Jureidini, MD, a child psychiatrist with the University of Adelaide, Australia, noted in an editorial accompanying the article that he believes there is “little reason to think that any antidepressant is better than nothing for young people.”

“Prescribing might help the doctor feel like he or she is doing something, or help parents feel that something is being done, but the adolescent might feel it to be dismissive of their distress,” he added.

Anti-Anxiety Meds: Options, Side Effects & Alternatives

In 2006, as she was preparing for her wedding, panic attacks began to take over Kara Baskin’s life. “I worried constantly that I was on the edge of bankruptcy, or dying of cancer, or that my fiancé was about to be fired from his job,” she explains. “My fears and my panic kept me home from social events, caused me to fight with my fiancé, and led me to the emergency room with imagined heart attack.”

Things didn’t improve after the wedding. On her dream honeymoon to Hawaii, she spent most of the time not on the beach, but back in her room with her heart racing. She realized she needed help. Back home, she found a therapist and through a combination of medication and talk therapy was able to get her panic under control. Today she uses the medication only as needed.

Kara is one of an estimated 40 million adult Americans — 18.1 percent — who suffer from some form of anxiety disorder. While other therapies are available (see Therapy, Meditation, Sleep and Exercise Can Help Lessen Anxiety), many people with anxiety disorder will find their lives so disrupted that they will need the immediate relief that medication provides. While side effects of these are generally mild, there are precautions you need to take if you choose this route.

What is Anxiety Disorder?

The term “anxiety disorder” actually encompasses several different conditions: generalized anxiety disorder (GAD), panic attacks, social anxiety, specific phobias, and post-traumatic stress disorder.

Some anxiety is normal — even helpful. But for people with anxiety disorder, symptoms are so severe and frequent that they interfere with daily life. “For example, being a little anxious about an upcoming test can help you perform better,” says Katherine M. Moore, MD, Assistant Professor of Psychiatry at the Mayo Clinic in Rochester, MN. “A person with anxiety disorder may be so anxious that she can’t study productively or go to school on the day of the test.”

Symptoms of anxiety disorder can be mental (racing thoughts, constant worrying, restlessness and difficulty concentrating) and physical (heart palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness and chills or hot flashes). These symptoms can be so severe that they interfere with your relationships, keep you from being able to enjoy your life, or even make it difficult for you to leave your home.

Anti-Anxiety Meds and Their Side Effects

For patients who need to get these symptoms under control, the first choice of medication is usually either SSRIs (selective serotonin reuptake inhibitors, such as Celexa, Lexapro, Luvox, Paxil, Prozac and Zoloft) or SNRIs (serotonin-norepinephrine reuptake inhibitors, such as Efflexor and Cymbalta). Both these medication types increase the serotonin available in the brain. SNRIs also increase the availability of the neurotransmitter norepinephrine. Both serotonin and norepinephrine improve mood. These medications are effective for all anxiety disorders, and SNRIs are particularly helpful in the treatment of generalized anxiety disorder, according to the Anxiety and Depression Association of America (ADAA).

Side effects of these medications are generally mild and go away after the first few weeks of treatment. They can include insomnia, headache, sexual dysfunction, weight gain and nausea.

Even if you are pursuing other treatments, such as cognitive behavioral therapy, your doctor may recommend that you try one of these medications. “We often can do therapy without medication,” explains O. Joseph Bienvenu, MD, Phd, Associate Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, in Baltimore. “But it requires a lot of work and courage on the part of the patient. Sometimes medication just gives people the courage to pursue other treatments.”

While taking these medications, it’s best to limit your consumption of alcohol, says Dr. Moore. “Because, like alcohol, these medications are metabolized through the liver, while you are taking them you will feel the effects of alcohol more quickly,” she explains. It’s also important to not stop these medications suddenly. If you decide to stop taking them, work with your doctor to taper off the medication gradually, she says.

Another class of medications, benzodiazepines (including Klonopin, Xanax and Ativan), is sometimes prescribed for short-term management of severe symptoms, “if somebody has social phobia or panic symptoms so severe that she can’t leave her house,” for example, Dr. Moore says. They can also be used occasionally. “For example, if somebody with a fear of flying travels a couple of times a year, a dose before a flight can be helpful,” she explains.

The main concern with the ongoing use of benzodiazepenes is dependence and addiction, Moore says. With prolonged use, you may find you need to increase the dosage to achieve the same effect, she explains. For this reason, it is best to limit use them only occasionally or, if daily, for no more than 3 to 4 months, she Tricyclic antidepressants, such as amitriptyline, imipramine, and nortriptyline can also help control symptoms. But doctors avoid prescribing them because of their side effects, including low blood pressure, constipation, urinary retention, dry mouth and blurry vision.

Special Concerns for Women

The dramatic hormonal changes of pregnancy and the post-partum period can make this “a time when women with pre-existing anxiety disorders may see worsening of symptoms, and a time when new symptoms can emerge,” says Samantha Meltzer-Brody, MD, MPH, Director of the Perinatal Psychiatry Program at UNC Center for Women’s Mood Disorders, in Chapel Hill, NC.

Changing levels of the stress hormone cortisol at this time also combine with the outside stresses of adjusting to parenthood to make new mothers more susceptible to developing anxiety, she says. While some anxiety at this time is normal, she says, “seek help if you feel the anxiety is making it difficult for you to manage or to enjoy your baby,” she says.

“Many anti-anxiety medications are considered safe in pregnancy and while breastfeeding, she says. It is hard to give an exact list of safe medications,” she says, “because it needs to be discussed on a case-by-case basis.” So much depends on other factors, including the severity of the symptoms, previous response to treatment, and the dose prescribed, she explains. It’s important to discuss your own situation with your doctor before taking these medications in pregnancy. At this time, it may be best to combine behavioral therapy, which teaches you skills to manage your anxiety, with interpersonal therapy, which helps you manage the complex relationships with your spouse, baby, and your child’s grandparents at this difficult time. A November 2000 study of 120 women published in the Archives of General Psychiatry found that interpersonal psychotherapy is an “effective alternative to medication in the post-partum period.”

A Winning Combination

Whatever your stage of life, many people, like Kara, find that medication is most helpful when combined with some type of therapy. “The medication put me in the frame of mind to take that next step and get the help I needed,” she says. “Therapy helped me to be more aware of my mind and my body, to feel more in control, and to be aware of what makes me anxious. Now that I know what my triggers are, I can prepare myself if I know I am going to be in a stressful situation.”

Ellen Wlody is a writer who specializes in health and parenting topics. She lives in upstate New York with her husband, children, and two dogs.

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